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Bera D, Mukherjee SS, Majumder S, Sikdar S, Dasgupta K, Kar A, Kathuria S, Sarkar R. Positive QRS complex in limb lead 2 with negative QRS in lead 3 on surface electrocardiogram: A novel predictor for anterior location of right‐sided accessory pathways (10 to 1 o’clock on tricuspid annulus). J Cardiovasc Electrophysiol 2022; 33:953-961. [PMID: 35175685 DOI: 10.1111/jce.15418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - Ayan Kar
- Dept of Cardiology, RTIICS Kolkata India
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Yang JD, Sun Q, Guo XG, Zhou GB, Liu X, Wei HQ, Xie HY, Ma J. Outcomes of Different Ablation Approaches for Para-Hisian Accessory Pathway and Ablation Safety at Each Site. Front Cardiovasc Med 2022; 8:821988. [PMID: 35155622 PMCID: PMC8835724 DOI: 10.3389/fcvm.2021.821988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background This study describes the electrophysiologic characteristics of the para-hisian accessory pathway (AP), the outcome of different ablation approaches, and ablation safety at different sites. Method A total of 120 patients diagnosed as para-hisian AP were included in this study. The electrophysiologic characteristics and outcomes at different ablation sites were analyzed. Results In total, 107 APs and 13 APs were diagnosed as right anteroseptal (RAS) and right midseptal (RMS), respectively. The significant ECG difference between RAS and RMS was lead III, which mainly manifested as positive and negative delta waves, respectively. Catheter trauma to AP was recorded in 21 of 120 (17.5%) patients. The recurrence rate of direct ablation at the “bumped” sites was higher than the conventional ablation method (37.5 vs. 14.1 %, p = 0.036). For RAS APs, there was no significant difference in the success rate between the inferior vena cava (IVC) and superior vena cava (SVC) approaches (76.6 vs. 73.3%, p = 0.63). The RAS was separated into three regions: (1) Site 1: superior part above the real “His” recorded site with far-field “His” potential; (2) Site 2 (true para-hisian): the site with near-field “His” potential; and (3) Site 3: inferior part below the biggest real “His” with far-field “His” potential. Mid-septal was defined as an area that is bounded anteriorly by His recording location and posteriorly by the roof of coronary sinus (CS) ostium. The incidence of atrioventricular (AV) conduction injury at different sites was as follows: 3 of 6 (50%) at Site 2, 4 of 13 (30.8%) at RMS, 7 of 34 (20.6%) at Site 3, and 3 of 46 (6.5%) at Site 1. Even if ablation was performed at the atrial side of the para-hisian region, the right bundle branch block (RBBB) was caused in 6 patients (5%). Conclusion Ablation via IVC or SVC was comparative for para-hisian APs, but not for the noncoronary cusp (NCC) approach. The AV conduction injury risk ranks as follows: Site 2 > RMS > Site 3 > Site 1. RBBB could be caused while ablating at the atrial side, which could further demonstrate the His bundle longitudinal dissociation theory.
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Affiliation(s)
- Jian-du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-bu Zhou
- NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xu Liu
- Department of Cardiology, Beijing An-zhen Hospital, An Affiliate of Capital Medical University, Beijing, China
| | - Hui-qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hai-yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jian Ma
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Farré J, Anderson RH, Rubio JM, García-Talavera C, Sánchez-Quintana D, Bansal R, Lokhandwala Y, Cabrera JA, Wellens HJJ, Back Sternick E. Miniseries 2-septal and paraseptal accessory pathways-part III: mid-paraseptal accessory pathways-revisiting bypass tracts crossing the pyramidal space. Europace 2022; 24:662-675. [PMID: 34999785 DOI: 10.1093/europace/euab294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
The mid-paraseptal region corresponds to the portion of the pyramidal space whose right atrial aspect is known as the triangle of Koch. The superior area of this mid-paraseptal region is also para-Hisian, and is close to the compact atrioventricular node and the His bundle. The inferior sector of the mid-paraseptal area is unrelated to the normal atrioventricular conduction pathways. It is, therefore, a safe zone in which, if necessary, to perform catheter ablation. The middle part of the mid-paraseptal zone may, however, in some patients, house components of the compact atrioventricular node. This suggests the need for adopting a prudent attitude when considering catheter ablation in this area. The inferior extensions of the atrioventricular node, which may represent the substrate for the slow atrioventricular nodal pathway, take their course through the middle, and even the inferior, sectors of the mid-paraseptal region. In this review, we contend that the middle and inferior areas of the mid-paraseptal region correspond to what, in the past, was labelled by most groups as the 'midseptal' zone. We describe the electrocardiographic patterns observed during pre-excitation and orthodromic reciprocating tachycardia in patients with pathways ablated in the middle or inferior sectors of the region. We discuss the modification of the ventriculo-atrial conduction times during tachycardia after the development of bundle branch block aberrancy. We conclude that the so-called 'intermediate septal' pathways, as described in the era of surgical ablation, were insufficiently characterized. They should not be considered the surrogate of the 'midseptal' pathways defined using endocardial catheter electrode mapping.
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Affiliation(s)
- Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - José-Manuel Rubio
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Camila García-Talavera
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | | | - Raghav Bansal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid, Spain.,Universidad Europea, Madrid, Spain
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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Brembilla-Perrot B, Huttin O, Olivier A, Sellal JM, Villemin T, Manenti V, Moulin-Zinsch A, Marçon F, Simon G, Andronache M, Beurrier D, de Chillou C, Girerd N. Age-related location of manifest accessory pathway and clinical consequences. Indian Pacing Electrophysiol J 2016; 15:227-35. [PMID: 27134439 PMCID: PMC4834439 DOI: 10.1016/j.ipej.2016.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Accessory pathway (AP) ablation is not always easy. Our purpose was to assess the age-related prevalence of AP location, electrophysiological and prognostic data according to this location. METHODS Electrophysiologic study (EPS) was performed in 994 patients for a pre-excitation syndrome. AP location was determined on a 12 lead ECG during atrial pacing at maximal preexcitation and confirmed at intracardiac EPS in 494 patients. RESULTS AP location was classified as anteroseptal (AS)(96), right lateral (RL)(54), posteroseptal (PS)(459), left lateral (LL)(363), nodoventricular (NV)(22). Patients with ASAP or RLAP were younger than patients with another AP location. Poorly-tolerated arrhythmias were more frequent in patients with LLAP than in other patients (0.009 for ASAP, 0.0037 for RLAP, <0.0001 for PSAP). Maximal rate conducted over AP was significantly slower in patients with ASAP and RLAP than in other patients. Malignant forms at EPS were more frequent in patients with LLAP than in patients with ASAP (0.002) or PSAP (0.001). Similar data were noted when AP location was confirmed at intracardiac EPS. Among untreated patients, poorly-tolerated arrhythmia occurred in patients with LLAP (3) or PSAP (6). Failures of ablation were more frequent for AS or RL AP than for LL or PS AP. CONCLUSIONS AS and RLAP location in pre-excitation syndrome was more frequent in young patients. Maximal rate conducted over AP was lower than in other locations. Absence of poorly-tolerated arrhythmias during follow-up and higher risk of ablation failure should be taken into account for indications of AP ablation in children with few symptoms.
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Affiliation(s)
| | - Olivier Huttin
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Arnaud Olivier
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Jean Marc Sellal
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Thibaut Villemin
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Vladimir Manenti
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Anne Moulin-Zinsch
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - François Marçon
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Gauthier Simon
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Marius Andronache
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | - Daniel Beurrier
- Adult and Pediatric Cardiology, CHU de Brabois, Vandoeuvre Les Nancy, France
| | | | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 9501, Université de Lorraine, Institut Lorrain du cœur et des vaisseaux, CHU de Nancy, Nancy, France
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González-Torrecilla E, Peinado R, Almendral J, Arenal A, Atienza F, García Fernández J, Fernández-Avilés F. Reappraisal of classical electrocardiographic criteria in detecting accessory pathways with a strict para-Hisian location. Heart Rhythm 2012; 10:16-21. [PMID: 23079032 DOI: 10.1016/j.hrthm.2012.08.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification of electrocardiographic (ECG) criteria for para-Hisian accessory pathways (APs) is based on a small series of patients. The presence of a negative delta wave in leads V(1) and V(2) has been suggested as an ECG marker of this AP location. OBJECTIVE To validate these ECG findings in a large series of patients with strict invasive criteria for that location. METHODS We included 105 patients (39 women, 66 men; mean age 26 ± 12 years, range 5-82 years) with an ECG pattern compatible with preexcitation through an anteroseptal or midseptal AP following established ECG criteria. A para-Hisian AP was defined when the location of its successful catheter ablation coincided with either the largest recordable His bundle electrogram or a His bundle potential of>0.1 mV. Patients without that definition were included in the control group. RESULTS A para-Hisian location of the AP was found in 52 patients. AP locations of the remaining 53 patients (control group) were anteroseptal (n = 39), midseptal (n = 9), and fasciculoventricular (n = 5). A negative delta wave in leads V(1) and V(2) was observed in 13 patients with para-Hisian APs (sensitivity 25%; specificity 92%). However, the sum of initial r-wave amplitudes in those leads was<0.5 mV in 44 of the patients with para-Hisian APs and in 13 patients of the control group (sensitivity 85%; specificity 75.5%; area under receiver-operator characteristic curve 0.85). CONCLUSIONS The presence of negative delta waves in leads V(1) and V(2) indicates a poor sensitivity and high specificity to detect APs with a strict definition of para-Hisian location. The sum of initial r-wave amplitudes in those ECG leads could be a useful, adjunctive marker in the noninvasive identification of these challenging APs.
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Affiliation(s)
- E González-Torrecilla
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
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Huang D, Yamauchi K, Inden Y, Yang J, Jiang Z, Ida H, Katsuyama K, Wang K, Kato K, Kato H. Use of an artificial neural network to localize accessory pathways of Wolff–Parkinson–White syndrome with12-lead electrocardiogram. ACTA ACUST UNITED AC 2009; 30:277-86. [PMID: 16531354 DOI: 10.1080/14639230500367670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Today, radio-frequency ablation has been shown to be a safe and effective method to treat paroxysmal tachycardia with Wolff-Parkinson-White syndrome. The many criteria reported for localizing the sites of accessory pathways from a 12-lead electrocardiogram have not proven adequate to differentiate the correct sites of accessory pathways for all situations. This study trained an artificial neural network to differentiate the varied features needed to localize 10 sites of accessory pathways. One hundred fifty patients underwent successful catheter ablation, with manifest single and antegradely conducting accessory pathways. Using the two electrocardiogram features of polarity of delta wave and R wave's share of QRS complex, an artificial neural network learned the characteristics of electrocardiogram waves for each site of the 10 accessory pathways through 90 learning cases, and an applicable network model was developed for testing. In 58 of 60 test cases (96.7%), sites of accessory pathways were localized correctly by the network. Based on the method employed in the present study, it thus becomes possible to predict the sites of accessory pathways with Wolff-Parkinson-White syndrome in more detail by using an artificial neural network with a 12-lead electrocardiogram. In the future, when this method is incorporated into a conventional automatic electrocardiogram system which could analyze delta waves and ORS complex, it will become useful to automatically diagnose the locations of the accessory pathways with Wolff-Parkinson-White syndrome in clinical practice.
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Affiliation(s)
- Damin Huang
- Department of Medical Information and Management Science, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Huttin O, Brembilla-Perrot B. [Relationships between age and accessory pathway location in Wolff-Parkinson-White syndrome]. Ann Cardiol Angeiol (Paris) 2008; 57:225-30. [PMID: 18550025 DOI: 10.1016/j.ancard.2008.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 03/25/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiofrequency ablation of atrioventricular accessory pathway (AP) which is currently used, remains associated with a risk of complete AV block in the case of anteroseptal (AS) location and its indication remains debatable. The purpose of the study was to evaluate the frequency of AS location in Wolff-Parkinson-White syndrome (WPW) and the clinical and electrophysiological data of these patients. METHODS Electrophysiologic study (EPS) was performed in 503 pts aged from six to 85 years (35+/-17), 297 men, 206 women, recruited for a patent WPW syndrome. The location of AP was determined on a 12 lead ECG during atrial pacing at maximal preexcitation according to classical criteria. The location was confirmed at EPS. Eleven pts were excluded because the location remained not clearly defined. EPS was indicated for suspected or documented tachycardias (n=264), syncope (n=68) or was systematic in asymptomatic patients (n=171). RESULTS AS AP location was identified in 34 patients aged eight to 48 years (7%). Their mean age was younger than the age of remaining population (25+/-13 versus 36+/-17, p<0.001). According to the age, the prevalence of AS location was significantly higher in children and adolescents (14%) than after 40 years (3%) (p<0.01). There was no AS location among 108 patients aged more than 50 years. The maximal rate conducted over AP was lower in patients with AS location than in other locations either in control state (174+/-60 per minute versus 197+/-63 per minute) (p<0.01) or after isoproterenol (206+/-71 versus 248+/-69) (p<0.01). The number of induced reciprocating tachycardia (47% versus 57.5%), atrial fibrillation (15% versus 21%) and malign forms (12% versus 17%) did not differ significantly in patients with AS location and in other patients. Anterograde conduction disappeared spontaneously in three of six patients followed 8+/-1.5 years, and significantly increased in two other patients. CONCLUSIONS AS AP location in WPW syndrome was more frequent in children than in adults. The maximal rate conducted over the AP was lower than in other locations. The incidence decreased after 40 years. AS AP location was never noted after 50 years in our population. This disappearance with age should be taken into account for the indications of AS AP ablation.
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Affiliation(s)
- O Huttin
- Département de cardiologie et pathologies vasculaires, CHU Brabois, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
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Haghjoo M, Kharazi A, Fazelifar AF, Alizadeh A, Emkanjoo Z, Sadr-Ameli MA. Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and posteroseptal accessory pathways. Heart Rhythm 2007; 4:1411-9. [DOI: 10.1016/j.hrthm.2007.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 07/02/2007] [Indexed: 11/25/2022]
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Catheter Ablation of Supraventricular and Ventricular Arrhythmias. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Steinberg JS. Desperately Seeking a Randomized Clinical Trial of Resynchronization Therapy for Patients With Heart Failure and Atrial Fibrillation⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2006; 48:744-6. [PMID: 16904543 DOI: 10.1016/j.jacc.2006.05.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chang SL, Lee SH, Tai CT, Chiang CE, Cheng JJ, Lin YJ, Hsieh MH, Lee KT, Tsao HM, Kuo JY, Chen YJ, Chen SA. Electrocardiographic and Electrophysiologic Characteristics of Midseptal Accessory Pathways. J Cardiovasc Electrophysiol 2005; 16:237-43. [PMID: 15817078 DOI: 10.1046/j.1540-8167.2005.40485.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of the present study was to investigate the electrocardiographic and electrophysiologic characteristics of right midseptal (RMS) and left midseptal (LMS) accessory pathways (APs), and to develop a stepwise algorithm to differentiate RMS from LMS APs. METHODS AND RESULTS From May 1989 to February 2004, 1591 patients with AP-mediated tachyarrhythmia underwent RF catheter ablation in this institution, and 38 (2.4%) patients had MS APs. The delta wave and precordial QRS transition during sinus rhythm, retrograde P wave during orthodromic tachycardia, and electrophysiologic characteristic and catheter ablation in 30 patients with RMS APs and 8 patients with LMS APs were analyzed. There was no significant difference in electrophysiologic characteristics and catheter ablation between RMS and LMS APs. The polarity of retrograde P wave during orthodromic tachycardia also showed no statistical difference between patients with RMS and LMS APs. The delta wave polarity was positive in leads I, aVL, and V3 to V6 in patients with RMS and LMS APs. Patients with LMS APs had a higher incidence of biphasic delta wave in lead V1 than patients with RMS APs (80% vs. 15%, P=0.012). The distributions of precordial QRS transition were different between RMS APs (leads V2; n = 10, V3; n = 7 and V4; n = 3) and LMS APs (leads V1; n = 1 and V2; n = 4) (P = 0.03). The combination of a delta negative wave in lead V1 or precordial QRS transition in lead V3 or V4 had a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 66% in predicting an RMS AP. CONCLUSIONS Delta wave polarity in lead V1 and precordial QRS transition may differentiate RMS and LMS APs.
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Affiliation(s)
- Shih-Ling Chang
- Department of Medicine and Cardiovascular Research Center, National Yang-Ming University, Fu Jen Catholic University, Veterans General Hospital, Taipei, Taiwan, ROC
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12
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Sternick EB, Rodriguez LM, Gerken LM, Wellens HJJ. Electrocardiogram in patients with fasciculoventricular pathways: A comparative study with anteroseptal and midseptal accessory pathways. Heart Rhythm 2005; 2:1-6. [PMID: 15851255 DOI: 10.1016/j.hrthm.2004.10.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2004] [Accepted: 10/04/2004] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the ECG profile of a cohort of patients with fasciculoventricular pathways and compare the profile with the ECG of patients with anteroseptal and midseptal accessory pathways. BACKGROUND Electrophysiologic findings suggest fasciculoventricular pathways insert into the septal region. Findings also suggest the 12-lead surface ECG during sinus rhythm is similar to the ECG of patients with anteroseptal and midseptal bypass tracts. METHODS Four different observers analyzed the 12-lead ECG of seven patients with fasciculoventricular pathways (group I) and the ECG of 20 patients with midseptal AV accessory pathways (group II) and 20 patients with anteroseptal AV accessory pathways (group III). The following variables were analyzed: ECG frontal plane QRS and delta wave axis; angle between the QRS and the delta wave axis; QRS width; R/S ratio in lead III; presence of a negative delta wave in inferior leads; and precordial lead transition to R/S >1. RESULTS The ECG of fasciculoventricular pathways shows a variable pattern. It shares some features with an anteroseptal accessory pathway and others with a midseptal accessory pathway. A narrower QRS width was the most important variable in distinguishing a fasciculoventricular pathway from a septally located AV bypass tract (P <.0001). The angle between the QRS and the delta wave frontal plane axis could differentiate a fasciculoventricular pathway from an anteroseptal bypass tract (P <.0001) but not from a midseptal accessory pathway. CONCLUSIONS The sinus rhythm ECG of patients with fasciculoventricular pathways shows similarities with ECGs of patients with anteroseptal and midseptal accessory pathways, but the QRS complex usually is narrower. The ECG recorded during sinus rhythm cannot reliably differentiate fasciculoventricular pathways with a broad QRS complex from anteroseptal or midseptal bypass tracts.
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Affiliation(s)
- Eduardo Back Sternick
- Department of Arrhythmia and Electrophysiology, Biocor Instituto, Nova Lima, Brazil.
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Oh S, Choi YS, Choi EK, Kim HS, Sohn DW, Oh BH, Lee MM, Park YB. Electrocardiographic Characteristics of Fasciculoventricular Pathways. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:25-8. [PMID: 15660798 DOI: 10.1111/j.1540-8159.2005.09371.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Fasciculoventricular (FV) pathways are rare variants of preexcitation, and their ECGs may be misinterpreted as Wolff-Parkinson-White syndrome with anteroseptal accessory pathways (WPW-AS). We analyzed the electrocardiographic characteristics of the patients with FV pathways to find out the different findings from WPW-AS. METHODS AND RESULTS Five patients with FV pathways and four patients with WPW-AS who underwent electrophysiologic studies were evaluated. Intervals and amplitudes of each wave and QRS morphologies were analyzed in standard 12-lead ECGs of these patients by two independent cardiologists without the information of the electrophysiologic findings. PR intervals were longer in FV pathways (122 +/- 11.0 vs 83 +/- 21 ms, FV pathways vs WPW-AS, P = 0.017). In lead V1, narrower width of R waves (25 +/- 6 vs 45 +/- 13 ms, P = 0.037) and smaller amplitude of S waves (12.8 +/- 8.3 vs 26.6 +/- 7.4 mm, P = 0.037) were observed in FV pathways. The polarity of delta waves in V1 was flat or negative in contrast with the cases of WPW-AS in which the polarity was positive. Three of five patients had notching in the descending limb of S waves in V1, which was not observed in WPW-AS. CONCLUSION FV pathways have different ECG characteristics from WPW-AS in PR interval and morphology of QRS complexes in lead V1 of the standard 12-lead ECG.
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Affiliation(s)
- Seil Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Basiouny T, de Chillou C, Fareh S, Kirkorian G, Messier M, Sadoul N, Chevalier P, Magnin-Poull I, Blankoff I, Chen J, Touboul P, Aliot E. Accuracy and limitations of published algorithms using the twelve-lead electrocardiogram to localize overt atrioventricular accessory pathways. J Cardiovasc Electrophysiol 1999; 10:1340-9. [PMID: 10515558 DOI: 10.1111/j.1540-8167.1999.tb00189.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the accuracy and limitations of published algorithms using the 12-lead ECG to localize AV accessory pathways (APs). METHODS AND RESULTS The 11 relevant algorithms found in the literature (MEDLINE database and major scientific sessions) were tested on a series of 266 consecutive patients who successfully underwent radiofrequency catheter ablation of a single overt AV AP. The positive predictive values (PPV) of the algorithms in applicable patients were significantly lower for algorithms with > 6 accessory location sites (40.6% +/- 10.9% vs 61.2% +/- 8.0%; P < 0.03) and show a tendency for algorithms not relying on delta wave polarity but on QRS polarity only (36.6% +/- 11.2% vs 52.3% +/- 13.1%; P = 0.09). The PPV in applicable patients is related to the AP location (P < 0.001) and ranked from the highest to the lowest as follows: left lateral (mean PPV = 86.3%), posteroseptal (mean PPV = 65.2%), right anteroseptal (mean PPV = 45.2%), and right posterolateral (mean PPV = 23.4%). CONCLUSION Our study suggests that the accuracy of algorithms relying on the 12-lead ECG depends on AP locations as defined in the algorithms and on the number of AP sites. The accuracy tends to be lower when delta wave polarity is not included in the algorithm's architecture. This should be considered when using these algorithms or when building new ones.
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Affiliation(s)
- T Basiouny
- Service de Cardiologie, Hôpital Central, Nancy, France
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15
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Tai CT, Chen SA, Chiang CE, Chang MS. Characteristics and radiofrequency catheter ablation of septal accessory atrioventricular pathways. Pacing Clin Electrophysiol 1999; 22:500-11. [PMID: 10192859 DOI: 10.1111/j.1540-8159.1999.tb00478.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Septal accessory AV pathways are located in the complex AV septal space that also contains the specialized conduction system. They have unique electrocardiographical and electrophysiological characteristics to be differentiated from free-wall accessory pathways. Some of the septal pathways have AV nodelike conduction properties and produce a similar activation sequence in the retrograde conduction. Several methods have been developed to distinguish them from AV nodal pathways. Radiofrequency catheter ablation using the titration method and endocardial approach without entrance into the coronary sinus is effective in eliminating most of the septal accessory pathways without impairment of AV conduction. However, some posteroseptal accessory pathways may require energy application inside the coronary sinus, thus information of the coronary sinus anatomy is important for preventing complication.
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Affiliation(s)
- C T Tai
- Department of Medicine, National Yang-Ming University, School of Medicine, Taiwan, R.O.C
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16
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Arruda MS, McClelland JH, Wang X, Beckman KJ, Widman LE, Gonzalez MD, Nakagawa H, Lazzara R, Jackman WM. Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 1998; 9:2-12. [PMID: 9475572 DOI: 10.1111/j.1540-8167.1998.tb00861.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Delta wave morphology correlates with the site of ventricular insertion of accessory AV pathways. Because lesions due to radiofrequency (RF) current are small and well defined, it may allow precise localization of accessory pathways. The purpose of this study was to use RF catheter ablation to develop an ECG algorithm to predict accessory pathway location. METHODS AND RESULTS An algorithm was developed by correlating a resting 12-lead ECG with the successful RF ablation site in 135 consecutive patients with a single, anterogradely conducting accessory pathway (Retrospective phase). This algorithm was subsequently tested prospectively in 121 consecutive patients (Prospective phase). The ECG findings included the initial 20 msec of the delta wave in leads I, II, aVF, and V1 [classified as positive (+), negative (-), or isoelectric (+/-)] and the ratio of R and S wave amplitudes in leads III and V1 (classified as R > or = S or R < S). When tested prospectively, the ECG algorithm accurately localized the accessory pathway to 1 of 10 sites around the tricuspid and mitral annuli or at subepicardial locations within the venous system of the heart. Overall sensitivity was 90% and specificity was 99%. The algorithm was particularly useful in correctly localizing anteroseptal (sensitivity 75%, specificity 99%), and mid-septal (sensitivity 100%, specificity 98%) accessory pathways as well as pathways requiring ablation from within ventricular venous branches or anomalies of the coronary sinus (sensitivity 100%, specificity 100%). CONCLUSION A simple ECG algorithm identifies accessory pathway ablation site in Wolff-Parkinson-White syndrome. A truly negative delta wave in lead II predicts ablation within the coronary venous system.
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Affiliation(s)
- M S Arruda
- Department of Medicine, University of Oklahoma Health Sciences Center, Department of Veterans Affairs Medical Center, Oklahoma City 73190-3048, USA
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17
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Lorga Filho A, Sosa E, Scanavacca M, d'Avila A, Kuniyoshi R, de Horta J, Fenelon G, Brugada P. Electrocardiographic identification of mid-septal accessory pathways in close proximity to the atrioventricular conduction system. Pacing Clin Electrophysiol 1996; 19:1984-7. [PMID: 8945082 DOI: 10.1111/j.1540-8159.1996.tb03266.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to identify ECG characteristics of overt mid-septal accessory pathways (APs) predictive of close proximity to the AV conduction system we analyzed data from patients who underwent successful RF catheter ablation of a mid-septal AP. Mean patient age was 31 +/- 16 years, and 13 were male. The 40 degrees right anterior oblique view was used to divide the mid-septal area into 3 zones: 1 (anterior portion); 2 (intermediate); and 3 (posterior portion). The 12-lead ECG was analyzed with regard to delta wave polarity and R/S transition in the precordial leads. The findings from patients ablated at zone 3 were compared to those at zones 1 and 2. All patients had a positive delta wave in the leads I, II, aVL, and negative delta wave in the leads III and aVR. The R/S transition occurred in lead V2 in 80% of patients. The delta wave in lead aVF was the only ECG characteristic that correlated with the AP ablation zone. Six of 8 patients ablated at zone 3 had a negative delta wave in lead aVF while 6 out of 7 patients ablated at zone 1 or 2 had a positive or isoelectric delta wave in lead aVF (P = 0.03). A positive or isoelectric delta wave in lead aVF identifies mid-septal AP in close proximity to the AV conduction system.
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18
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Iturralde P, Araya-Gomez V, Colin L, Kershenovich S, de Micheli A, Gonzalez-Hermosillo JA. A new ECG algorithm for the localization of accessory pathways using only the polarity of the QRS complex. J Electrocardiol 1996; 29:289-99. [PMID: 8913903 DOI: 10.1016/s0022-0736(96)80093-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A new algorithm is proposed for localization of accessory atrioventricular pathways by use of a 12-lead electrocardiogram (ECG). The polarity of the QRS complex in leads III, V1, and V2 from 102 patients with Wolff-Parkinson-White syndrome with manifested preexcitation who underwent successful radiofrequency catheter ablation was analyzed. Accessory pathways on the right side of the heart were localized to three regions around the tricuspid annulus, and left-sided pathways were localized to two regions around the mitral valve annulus. In 42 of 46 patients (91%) with left posterolateral accessory pathways, a common characteristic of the ECG was a positive QRS complex in leads III and V1 (sensitivity 91%, specificity 95%). Of 19 patients with left inferior paraseptal or inferior accessory pathways, 16 (84%) had a negative QRS complex in lead III and a positive QRS complex in lead V1 (sensitivity 84%, specificity 98%). All six patients with right anterosuperior paraseptal accessory pathways had a positive QRS complex in lead III but a negative QRS complex in lead V1 (sensitivity 100%, specificity 97%). The 25 patients with right inferior paraseptal or inferior accessory pathways had a negative or isodiphasic QRS complex in leads III and V1, but the QRS complex was positive in lead V2 in 21 (84%) of these patients (sensitivity 84%, specificity 100%). Finally, five of the six patients (83%) with right anterior accessory pathways had a negative QRS complex in leads III, V1, and V2 (sensitivity 83%, specificity 96%). With the algorithm, the localization of accessory pathways was thus identified in 90 of the 102 patients (88%).
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Affiliation(s)
- P Iturralde
- Electrophysiology Department, Instituto Nacional de Cardiología Ignacio Chávez, México DF
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19
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Riva SI, Della Bella P, Fassini G, Carbucicchio C, Tondo C. Value of analysis of ST segment changes during tachycardia in determining type of narrow QRS complex tachycardia. J Am Coll Cardiol 1996; 27:1480-5. [PMID: 8626962 DOI: 10.1016/0735-1097(96)00013-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Repolarization changes during narrow QRS complex tachycardia were analyzed to differentiate the tachycardia mechanism and to guide the preliminary location of the accessory pathway. BACKGROUND Noninvasive determination of the mechanism of tachycardia is becoming increasingly important in view of the role of catheter ablation techniques for the cure of supraventricular tachycardia. METHODS We analyzed 159 12-lead electrocardiograms during narrow QRS complex tachycardia to evaluate 1) the tachycardia cycle; and 2) ST segment depression or T wave inversion, or both. Each patient underwent a complete electrophysiologic evaluation. RESULTS There were 13 atrial tachycardias, 57 atrioventricular (AV) node reentrant tachycardias and 89 AV reciprocating tachycardias. The mean RR cycle did not differ among types of tachycardia. ST segment depression >2 mm or T wave inversion, or both, was present more often in AV reciprocating tachycardia (57%) than in AV node tachycardia (25%). The magnitude of ST segment depression was greater in AV reciprocating tachycardia than in AV node tachycardia (mean +/- SD 1.3 +/- 1.6 vs. 0.7 +/- 0.8 mm, p < 0.005). In AV reciprocating tachycardia distinct patterns of repolarization changes and P wave configuration were associated with different sites of the accessory pathway. CONCLUSIONS The presence of ST segment depression >2 mm or T wave inversion, or both, during narrow QRS complex tachycardia suggests that AV reentry using an accessory pathway is the mechanism of the tachycardia. The phenomenon may be the consequence of a distinct pattern of retrograde atrial activation. Analysis of repolarization changes can guide preliminary localization of the accessory pathway even in the absence of ventricular preexcitation.
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Affiliation(s)
- S I Riva
- Instituto di Cardiologia, Universitá degli Studi, Milan, Italy
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20
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Lee KL, Lauer MR, Young C, Chun H, Liem LB, Sung RJ. Characteristic electrocardiographic features of manifest left anterior paraseptal accessory atrioventricular connection. Am Heart J 1996; 131:814-8. [PMID: 8721658 DOI: 10.1016/s0002-8703(96)90290-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K L Lee
- Cardiac Electrophysiology Laboratories, Stanford University Medical Center, Stanford, CA 94305, USA
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21
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Tai CT, Chen SA, Chiang CE, Lee SH, Chang MS. Electrocardiographic and electrophysiologic characteristics of anteroseptal, midseptal, and para-Hisian accessory pathways. Implication for radiofrequency catheter ablation. Chest 1996; 109:730-40. [PMID: 8617084 DOI: 10.1378/chest.109.3.730] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
STUDY OBJECTIVE To investigate the ECG characteristics, the electrophysiologic properties, and an effective radiofrequency catheter ablation technique in patients with septal accessory pathways. PATIENTS Forty-six consecutive subjects with septal accessory pathways located in the anteroseptal, midseptal, and para-Hisian areas. DESIGN AND INTERVENTIONS ECGs obtained during sinus rhythm and orthodromic tachycardia, conduction properties obtained from electrophysiologic study, and results of two different ablation techniques were analyzed. MEASUREMENTS AND RESULTS (1) Twenty-four (52.2%) had manifest preexcitation and 15 (32.6%) had multiple accessory pathways; (2) midseptal pathways could be differentiated from anteroseptal and para-Hisian pathways by a negative delta wave in lead III and a biphasic delta wave in lead aVF during sinus rhythm, and a negative retrograde P wave in two inferior leads during orthodromic tachycardia; (2) midseptal pathways had better antegrade conduction properties and a significantly higher incidence (61.5%) of inducible atrial fibrillation; (4) radiofrequency catheter ablation using lower energy (20+/-6 W) had a comparable effect to ablation using higher energy (36+/-5 W), but without impairment of atrioventricular (AV) node conduction or development of AV block; and (5) during the follow-up period of 26+/-14 months (range, 5 to 54 months), three (6.5%) patients had recurrence. CONCLUSIONS Midseptal accessory pathways had ECG and electrophysiologic characteristics that were distinctive from those of anteroseptal and para-Hisian pathways. Catheter ablation of these septal pathways using low radiofrequency energy was safe and effective.
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Affiliation(s)
- C T Tai
- Division of Cardiology, Department of Medicine, National Yang-Ming University, School of Medicine, Taipei, Taiwan, Republic of China
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22
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d'Avila A, Brugada J, Skeberis V, Andries E, Sosa E, Brugada P. A fast and reliable algorithm to localize accessory pathways based on the polarity of the QRS complex on the surface ECG during sinus rhythm. Pacing Clin Electrophysiol 1995; 18:1615-27. [PMID: 7491305 DOI: 10.1111/j.1540-8159.1995.tb06983.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many criteria have been published to localize accessory pathways from the 12-lead ECG during sinus rhythm. This study analyzed whether the localization of an accessory pathway could be predicted by using the polarity of the QRS complex during sinus rhythm on the surface ECG, instead of the delta wave polarity as used in many reports. METHODS The ECGs of 140 patients with an overt and single accessory pathway were evaluated. Eight localizations were taken into account. The precise location was previously known from successful radiofrequency ablation sites. RESULTS In 128 patients (92%), the new algorithm allowed an accurate diagnosis of the site of implantation of the accessory pathway. CONCLUSION Analysis of the polarity of the QRS complex on five electrocardiographic leads provides an easy, fast and reliable way to localize accessory pathways during sinus rhythm.
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Affiliation(s)
- A d'Avila
- Cardiovascular Center, O.L.V. Hospital, Aalst, Belgium
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23
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Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, van den Dool A, Wellens HJ. Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 1995; 76:492-4. [PMID: 7653450 DOI: 10.1016/s0002-9149(99)80136-2] [Citation(s) in RCA: 202] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a population of 690 patients with Wolff-Parkinson-White (WPW) syndrome referred to our hospital from January 1979 to February 1995, 15 patients (2.2%) had an aborted sudden death out of the hospital. This retrospective study examines their clinical and electrophysiologic characteristics. Gender, accessory pathway localization, and presence of multiple accessory pathways were compared between patients with and without spontaneous ventricular fibrillation (VF). Whereas gender and the presence of multiple accessory pathways did not significantly differ between both groups, septally located pathways occurred significantly more often in the VF group. In patients with aborted sudden death, spontaneous VF was found significantly more often in men (13 of 15). VF was the first manifestation of the WPW syndrome in 8 patients. The remaining 7 patients had documented episodes of atrial fibrillation, circus movement tachycardia, or both (n = 2). Ten of the 15 patients were exercising or under emotional stress at the time of aborted sudden death. Only 1 patient had 2 accessory pathways. The location of the accessory pathway was septal (midseptal or posteroseptal) in 11 patients, left lateral in 4, and right lateral in 1).
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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Chiang CE, Chen SA, Teo WS, Tsai DS, Wu TJ, Cheng CC, Chiou CW, Tai CT, Lee SH, Chen CY. An accurate stepwise electrocardiographic algorithm for localization of accessory pathways in patients with Wolff-Parkinson-White syndrome from a comprehensive analysis of delta waves and R/S ratio during sinus rhythm. Am J Cardiol 1995; 76:40-6. [PMID: 7793401 DOI: 10.1016/s0002-9149(99)80798-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prediction of accessory pathway location before radio-frequency ablation has become increasingly important for patients with Wolff-Parkinson-White syndrome. However, existing electrocardiographic (ECG) criteria for localization of accessory pathways have several limitations, and the polarity of delta waves has not been well defined. In the present study, 369 patients with a single anterogradely conducting accessory pathway who underwent successful radiofrequency ablation were included. The polarity of delta waves was defined and categorized in detail, and various ECG characteristics of the most preexcited QRS complexes were examined and compared with QRS complexes after successful ablation in the initial 182 patients, which included morphology and polarity of delta waves, initial 20, 40, and 60 ms segments of the preexcited QRS complex, R/S ratio in the precordial leads, R/S ratio in the frontal leads, delta wave axis in the frontal plane, polarity of delta waves in the frontal leads, and polarity of delta waves in the precordial leads. The polarity of the initial 40 ms segment of the most preexcited QRS complexes in each of the frontal leads, and the polarity of the initial 60 ms segment of the most preexcited QRS complex in each of the precordial leads proved to be the best representatives of delta wave polarity in the respective leads.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- C E Chiang
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Mushahwar SS, Mullins PA. Palpitations in a 43-year-old man. Postgrad Med J 1995; 71:181-5. [PMID: 7746783 PMCID: PMC2398175 DOI: 10.1136/pgmj.71.833.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- S S Mushahwar
- Department of Cardiology, Royal Liverpool University Hospital, UK
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27
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Timmermans C, Smeets JL, Rodriguez LM, Oreto G, Medina E, Notheis W, Vrouchos G, Weide A, Wellens HJ. Recurrence rate after accessory pathway ablation. BRITISH HEART JOURNAL 1994; 72:571-4. [PMID: 7857742 PMCID: PMC1025646 DOI: 10.1136/hrt.72.6.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate characteristics of patients and accessory pathways as well as additional technical factors involved in the reappearance of accessory pathway conduction after successful ablation. DESIGN Analysis of recurrences after radiofrequency ablation. SETTING 163 consecutive patients with 167 accessory pathways. SUBJECTS 97 men and 66 women with a mean (SD) age of 36 (14) range (11 to 75) years. RESULTS After a mean (SD) follow up of 14 (7) range (2 to 27) months, conduction recurred in 13 out of 167 (7.8%) accessory pathways. The initial manifestation of recurrence was circus movement tachycardia in 7 patients and reappearance of delta waves on a 12 lead electrocardiogram in 6 patients. The interval to the return of accessory pathway conduction ranged from 3 hours to 90 days. Age, sex, presence of multiple accessory pathways, criteria to determine the target ablation site, number and duration of radiofrequency applications, and cumulative energy did not significantly differ between the groups with recurrence and without. Recurrence was less common with concealed accessory pathways (2/44) than with overt accessory pathways (11/110). The difference was not significant. The only variable to influence the recurrences in this study group was the location of the accessory pathway. Reappearance of conduction through right sided accessory pathways occurred significantly more often than through left sided ones (8/40 v 5/114, P = 0.01). CONCLUSION After radiofrequency ablation the recurrence rate of accessory pathways is low and there are no predictors of the risk of reappearance of conduction apart from the right sided location of the accessory pathway.
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Affiliation(s)
- C Timmermans
- Department of Cardiology, Academic Hospital, Maastricht, The Netherlands
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